Post-abortion care (PAC) integrates elements of care that are vital for women’s survival after abortion complications with intervention components that aid women in controlling their fertility, and provides an optimal window of opportunity to help women meet their family planning goals. Yet, incorporating quality family planning services remains a shortcoming of PAC services, particularly in low- and middle-income countries. This paper presents evidence from a mixed method study conducted in Tanzania that aimed at explaining factors that contribute to this challenge. Analysis of data obtained through client exit interviews quantified the level of unmet need for contraception among PAC clients and isolated the factors associated with post-abortion contraceptive uptake. Qualitative data analysis of interviews with a subset of these women explored the multi-level context in which post-abortion pregnancy intentions and contraceptive behaviours are formed. Approximately 30% of women interviewed (N=412) could recall receiving counselling on post-abortion family planning. Nearly two-thirds reported a desire to either space or limit childbearing. Of those who desired to space or limited childbearing, approximately 20% received a contraceptive method before discharge from PAC. The factors significantly associated with post-abortion contraceptive acceptance were completion of primary school, prior use of contraception, receipt of PAC at lower level facilities and recall of post-abortion family planning counselling. Qualitative analysis revealed different layers of contextual influences that shaped women’s fertility desires and contraceptive decision-making during PAC: individual (PAC client), spousal/partner-related, health service-related and societal. While results lend support to the concept that there are opportunities for services to address unmet need for post-abortion family planning, they also attest to the synergistic influences of individual, spousal, organizational and societal factors that influence whether they can be realized during PAC. Several strategies to do so emerged saliently from this analysis. These emphasize customized counselling to enable client–provider communication about fertility preferences, structural intervention aimed at empowering women to assert those objectives in family and health care settings, availability of information and services on post-abortion fertility and contraceptive eligibility in PAC settings and interventions to facilitate constructive spousal communication on family planning and contraceptive use, after abortion and in general.

中文翻译：

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流产后的生育欲望、避孕药具的使用和未满足的计划生育需求：坦桑尼亚流产后护理客户的声音

流产后护理 (PAC) 将流产并发症后对女性生存至关重要的护理要素与帮助女性控制生育能力的干预成分相结合，并提供最佳机会窗口来帮助女性实现其计划生育目标。然而，纳入优质的计划生育服务仍然是 PAC 服务的一个缺点，尤其是在低收入和中等收入国家。本文介绍了在坦桑尼亚进行的一项混合方法研究的证据，该研究旨在解释导致这一挑战的因素。通过客户退出访谈获得的数据分析量化了 PAC 客户中未满足的避孕需求水平，并分离了与流产后避孕药摄取相关的因素。对这些妇女子集的访谈定性数据分析探讨了流产后怀孕意图和避孕行为形成的多层次背景。约 30% 的受访女性（ñ=412) 可以回忆起接受过关于流产后计划生育的咨询。近三分之二的人表示希望空间或限制生育。在那些想要间隔或限制生育的人中，大约 20% 在从 PAC 出院前接受了避孕方法。与接受流产后避孕药具显着相关的因素是完成小学教育、事先使用避孕药具、在较低级别的设施接受 PAC 以及召回流产后计划生育咨询。定性分析揭示了影响 PAC 期间女性生育欲望和避孕决策制定的不同层面的背景影响：个人（PAC 客户）、配偶/伴侣相关、健康服务相关和社会。虽然结果支持了服务有机会解决未满足的流产后计划生育需求的概念，但它们也证明了个人、配偶、组织和社会因素的协同影响，这些因素会影响它们是否可以在 PAC 期间实现。从该分析中，显着地出现了几个这样做的策略。这些强调定制咨询以使客户与提供者能够就生育偏好进行沟通，旨在使妇女能够在家庭和医疗保健环境中坚持这些目标的结构性干预，关于流产后生育的信息和服务的可用性以及 PAC 环境中的避孕资格和干预措施促进在流产后和一般情况下就计划生育和避孕药具的使用进行建设性的配偶沟通。